472 ■ III: ROLE FUNCTIONS OF DOCTORAL ADVANCED NURSING PRACTICE
DNP degree construction and exclude the educator role. Therefore, the DNP
exam emphasizes the clinical practitioner role and any credible credential
that Doctor of Nursing Practice graduates can obtain that can differentiate
their practice beyond the MSN, is worthy of at least further trial and study.
(Dr. H. Michael Dreher, personal communication, May 10, 2010)
Dreher and Montgomery (2009) also suggest that the new term “doctoral advanced
practice nursing” be used to differentiate “master’s- level advanced practice nursing,”
and one could infer that this DNP examination may perhaps validate clinical practice
beyond current master’s APRN competencies.
In summary, proponents refute the criticisms of the DNP examination by asserting:
- It was never designed for nonclinical DNPs
- The boundaries between physician practice and even doctoral advanced prac-
tice nursing are quite clear - Concerns of physician regulation of NP practice are unfounded
- Multidisciplinary health care teams with clear professional boundaries repre-
sent the future of primary care to meet the needs of the underserved - The DNP certification is necessary to assure the public of high standards of
care - The DNP examination is worthy of further trial and study
In addition, proponents assert that the DNP certification examination supports the
uniform regulation of APRN practice via LACE. Finally, proponents assert that there is a
distinct difference between the practice of master’s- and DNP- prepared APRNs.
■ ARGUMENTS AGAINST THE DNP EXAMINATION
The most salient arguments against the DNP certification examination question the
validity of the examination for nonclinically based DNPs such as administrators and
educators. In addition, nonclinically based APRN administrators and educators earn-
ing a DNP are only required to be actively certified by the ANCC in their respective
roles. Those who oppose the examination cite the 50% pass rate achieved by 45 exam-
inees in 2008, 57% pass rate among 19 examinees in 2009, 45% pass rate among 31
examiners in 2010, 70% pass rate among 22 examiners in 2011, and a 33% pass rate
among 18 examiners in 2012 to bolster the argument against its validity (ABCC, 2015 ).
The American Association of Nurse Practitioners (AANP), American College of Nurse
Practitioners (ACNP), and some specialty groups of the American Medical Association
(AMA) have publicly expressed their opposition to the DNP examination (Guadagnino
& Mundinger, 2008; Hoyt & Proehl, 2009). Because those DNPs who pass the exami-
nation will use the title “doctor,” some argue that the boundaries between medicine
and nursing have been blurred to an extent that will cause public confusion. In addi-
tion, the use of the USMLE as the template for the DNP examination has raised some
concerns that the public will be misled to think that DNP certification is equivalent to
physician certification. Some opponents also express concern that NBME credentialing
will ultimately result in physician regulation of APRN practice, because the NBME is
viewed as a medical credentialing agency (National Organization of Nurse Practitioner
Faculties [NONPF], 2008).
Opponents also argue that there are already psychometrically sound national cer-
tifying examinations for APRNs and question the utility of an additional certification
examination (Counts & Dempster, 2008; Stanik- Hutt, 2008). They further argue that the